What is different about lifting for men

Articles about treatments for men usually begin with “men are different in these ways”. This article begins the other way round. Let us start with what has been tested.

The second row is particularly striking. Data on 142 men were already inside the analysis, and yet not a single line of results for men came out of it. It is not that the data were absent; it is that nobody broke them down.

The limitations section of the systematic review of 16 studies is also notable — the authors themselves wrote that “since male skin is different, it would be interesting to know whether these results are reproduced in men”.

So the premise of this article is this. The recommendations for lifting in men now in circulation are mostly carried over from data on women. That does not mean they are wrong, but we will not mix what has been verified with what has been carried over.

The sentence “men's skin is 20 to 25% thicker” appears often. We looked for the original source.

The abstract of the 1975 paper this figure traces back to opens as follows — “Collagen, dermal thickness and collagen density of forearm skin were measured.” The forearm, not the face. And the abstract contains no percentage figure.

So we replaced it with Asian data actually measured on the face.

There is also a study that did directly test the difference between the sexes. In a study of 118 people measuring 8 facial sites, the epidermis and dermis were significantly thicker in men than in women (with the malar epidermis and the neck dermis as the only exceptions).

And a clinically more interesting finding came out of that study.

In women, the skin thinned with age at the forehead · glabella · malar area · submandibular region, whereas in men an age correlation appeared at only one site, the malar dermis. In other words, men's facial skin thins less with age. This is a favourable condition for men — the tissue being treated is thicker and shrinks less over time.

The explanation that “men and women age skeletally at different times” is often seen. We checked the papers cited as evidence for it.

In a 2011 study measuring 120 white subjects with three-dimensional CT and a 2007 study of 60 subjects, every finding was described as occurring “in both sexes” — widening of the orbital aperture, a decrease in the glabellar angle and an increase in the mandibular angle were all significant in both sexes. A difference between the sexes in the timing of these changes is not reported in the abstracts of these papers.

Korean data point the same way.

• CT study of 114 Korean subjects: the canine fossa angle (the concavity at the front of the cheek) decreased significantly in both sexes.
• CT study of the forehead in 180 Korean subjects: the forehead flattened in both sexes. Men simply start from a more sloped forehead when young.

So we could not find evidence for the claim that “men age at a different time, so they should start at a different time”. What has been confirmed is that men and women change in the same direction. What differs is the starting point — men's forehead slope, mandibular angle and brow position begin in a different place to start with.

This is the only item in this article for which we can state flatly that “men are different in this way”. There is a dose-ranging randomised trial conducted in men only.

Compared with the standard glabellar dose of 20 units in women, that is double. The reason is muscle mass.

However, the same trial reports that adverse events also increased with dose. And in other data, satisfaction by dose was 60% at 40 units → 51% at 60 units → 39% at 80 units. It is not that more is better, but that the starting point is different.

When treatments for men are described, the phrase “enhancing the masculine contour” is common. What relationship this actually has with attractiveness has been measured.

These are the results of a 2023 study analysing 1,550 faces across 10 cultures.

In other words, the premise that “making a face more masculine makes it more attractive” has no evidence behind it. Unlike the contribution femininity made in female faces, masculinity in male faces had an effect close to zero.

What consistently lowered attractiveness in both sexes was “the degree of deviation from the average”. We have written about this topic in detail in what is the difference between a natural face and an artificial one?.

So setting the goal of treatment in men as “reducing what catches the eye” rather than “more masculine” fits the evidence. Conversely, we should also state that the concern that excessive volume makes a face look feminine has no measured data behind it either and rests only on expert opinion.

This subject always comes up when treatments for men are discussed, but this section is short. That is because we found almost nothing.

• “The skin of the beard area is more richly vascularised” — we could not find a study measuring this in humans. The search results were literature on shaving and studies of hair follicle vasculature in mice.
• “So it bruises more easily” — no studies.
• “A beard affects radiofrequency electrode contact or ultrasound transmission” — we could not find evidence of any kind. It is a completely untested area.
• A comparison of beard density between Korean men and Western men — we could not find data.

You must not read this as “there is no effect”. It is “it has never been tested”. When we treat the beard area cautiously in practice, we say so while stating that this is experience, not evidence.

There is one dataset on Asian men. It surveyed 302 men at the cosmetic consultation clinic of a university hospital dermatology department in Thailand.

• Motivation: improving appearance 88.4%, career · work 10.3%, peer pressure 9.6%
• Downtime: 81.5% preferred “gradual improvement with no downtime”. Those willing to accept a recovery period and resolve everything at once were 18.5%
• Willingness to accept treatments: lasers 75.8%, injectables 61.9%

Girdwichai N et al., JCAD 2018. This is not a lifting patient population but one in which acne · hair loss consultations predominate, and it is not Korean data. Even so, it is the largest dataset on Asian men that we found.

On pain, what has been measured points to there being no sex difference. In a study comparing 84 people who had facial laser treatment (42 men · 42 women), there was no statistically significant sex difference in mean pain. The authors concluded that pain tolerance for non-invasive procedures could be expected to be similar regardless of sex.

However, this study was on lasers, not radiofrequency or ultrasound. We could not find comparative data on sex differences in pain with lifting devices. Neither “you are a man, so bear it” nor “men feel more pain” has evidence behind it.

In 2025 a Korean research group published an ultrasound lifting protocol for Asian men. That paper contains this sentence.

“Although guidelines optimising ultrasound lifting have been developed, specific guidance for applying it to men does not currently exist.”

The paper itself is also not randomised, has no control group, does not state the number of patients, and has no quantitative outcome measures. In the authors' own words, it is “our experience”.

In other words, male lifting protocols exist, but they are experience, not evidence. And the field has written that fact down itself.

The reason we go out of our way to quote this sentence is that honesty is how this site works. There is at present no basis for packaging treatments for men as something special under the name of a “male-only protocol”.

1. We start toxin at a different dose. At least 40 units for the male glabella — the only item supported by a randomised trial conducted in men only. That said, we do not simply raise the dose without limit. Dose and satisfaction were not proportional.
2. We build the thicker skin into the plan. In facial ultrasound measurements men were thicker across the sites generally, and thinned less with age. That means the tissue being treated is thicker.
3. We do not set the goal as “more masculine”. Masculinity in male faces did not contribute to attractiveness (coefficient −0.03). Reducing what catches the eye fits the evidence.
4. We ask about downtime first. In a survey of 302 Asian men, 81.5% preferred gradual improvement with no downtime. We do not take a design that changes a great deal at once as the default.
5. We do not call it a “male-only protocol”. There is no trial supporting such a thing. Instead we plan by the same criteria — thickness · fat volume · degree of laxity — which we have set out in lifting treatments should differ according to skin thickness and fat volume.
6. We treat the beard area cautiously, while stating that this is experience. There is no measured evidence.

• Strong evidence — glabellar toxin in men should start at a minimum of 40 units. A double-blind randomised dose-ranging trial in 80 men.
• Moderate evidence — men's facial skin is thicker (ultrasound measurement of 118 · 200 Asian subjects) and thins less with age.
• Disproved — “making a face more masculine makes it more attractive”. Across 1,550 faces in 10 cultures, the coefficient for masculinity was −0.03, meaning no effect.
• Disproved — a sex difference in pain. In a comparison of 84 people there was no significant difference (though this was laser data).
• No evidence — that radiofrequency · ultrasound work differently in men. Of more than 60 studies, 0 reported sex-stratified results.
• Never tested — the effect of the beard area on vasculature · bruising · device transmission. We could not find evidence of any kind.
• Correction — the original source of “men's skin is 20 to 25% thicker” is the forearm, not the face.

So the conclusion of this article is not “men are different in these ways” but “almost nothing has been verified in men yet”. That does not mean we should not treat men. It means we apply the one thing that has been verified (toxin dose) firmly, and plan the rest by that person's thickness · fat volume · degree of laxity rather than by sex. Not filling the space where evidence is absent with the label “male-only” is, we think, the honest approach.

Written and reviewed by Lee Chi-Hak, MD, medical director of Miso Clinic in Daegu, South Korea. Every study cited above is given together with its design, its size and the limitations the authors themselves recorded, and where we could not find data, we have said that we could not find any.